Truthbutter

Palate Expansion Update: Concerning CBCT Scan Results

I am long overdue for a progress update! Last time I posted, I shared some progress pics, and was about to get a CBCT scan to reassure myself and my orthodontist that we weren’t pushing my teeth out of the bone.

Well…unfortunately, the CBCT scan was not reassuring. In fact, it was pretty concerning. At some point I’ll get around to posting screenshots from the scan, but for now, I’ll just share a snippet from the radiology report:

cbct scan results

In layman’s terms? Although the CBCT scan isn’t precise enough to tell us whether the roots of my teeth are fully poking through the bone, it can tell us that the bone outside of the roots on my upper teeth is extremely thin. And that’s not good.

Side note: Did you see what they said about my airway? Reduced airway space is one of the main risks of retractive orthodontics, and another reason why I need my maxilla expanded and pulled forward!

Anyway. Needless, to say, the CBCT results were pretty soul-crushing. I mean, I had spent a lot of time and money covering my bases and making sure I was doing this the right way, and I felt so confident that I was on the right track. Not only did this scan derail me completely, it also showed me that once again, all of the “experts” I had put my trust in might have been wrong.

The new plan

For now, I’m paused. Not quitting – just paused. I’m still wearing my expander at night to retain the expansion I’ve gotten so far, but I haven’t turned the key since I got the CBCT results back in July. And I gotta say – the silver lining of all this is not having to wear that dang thing during the day for now! So nice to not be all lispy and metallic.

I’ve sought advice from as many people as I could, but I still feel a little lost. The biggest letdown has been getting no response from Dr. Brad about my CBCT results. Prior to the scan, he was so confident in saying that the fear of pushing teeth out of the bone was just conventional wisdom. He had never had any issue with it, and my local orthodontist was just being paranoid. But sure, go ahead and get the scan for peace of mind.

Well, post-scan, me and my ortho have followed up with him countless times seeking his feedback and advice, but it’s just been crickets. You have no idea how much I hoped and prayed in that first week that he would come back with some kind of wisdom, like maybe “oh, that’s nothing to be concerned about. We’ve seen similar scans in our patients, but the body adapts, and the bone will regrow and thicken over time.” Or “huh, that is a little concerning. Why don’t you contact my office to make a phone appointment with me, and we can discuss further?” Or even “I’m sorry, this is not something I have experience with and am not able/willing to advise you.” But I got nothing.

I’m trying to give him the benefit of the doubt. Maybe he’s just really busy, and a non-local patient who only saw him once is not a priority. I guess I could understand that. But really, it just feels like yet another situation where a healthcare professional has talked a big game, convinced me that I could trust them, and then abandoned me and stuck their heads in the sand as soon as my experience didn’t align with their belief system. (Who’s bitter? I’m not bitter. Pshhh.)

I did have one reader mention that they were considering starting treatment with Dr. Brad, and wanted to check in on how my treatment was going before moving forward. I’ll just say that I no longer would enthusiastically recommend him, but I also wouldn’t necessarily warn people away from him. I’ll let you guys know if anything changes.

Thankfully, my local orthodontist (Mary Walton, located in Cary/Raleigh NC – go to her!) has been amazing. She’s been really understanding, didn’t say “I told you so” even though she totally could have, and is more than willing to be patient and be “paused” with me.

I also sought advice from a few others. Ian Hedley, a UK orthodontist who does adult palate expansion and NCR, was kind enough to respond to my email. He said:

“Pushing teeth off their bone support is always the orthodontists biggest fear. I have never had a patient who this has happened to, my only suggestion is that you slow down the rate of expansion so that the bone has time to remodel itself thus preventing dehiscence.”

(Dehiscence: loss of alveolar bone on the facial (rarely lingual) side of a tooth that exposes the root.)

I also talked to Mike Mew at this year’s Ancestral Health Symposium, and his work has given me a slightly different perspective that I’m definitely going to pursue. I’ll talk about all that more in a future post, I think, but for now, I am trying to incorporate “mewing” while the more aggressive expansion is paused.

Revised thoughts on palate expansion in adults

I can’t remember how much I’ve talked about the idea of adult palate expansion as a whole, but I wanted to briefly address the issue in light of these recent developments. Basically, there are two opposing camps:

Camp 1: Conventional Wisdom. Once you stop growing, true expansion of the palate is not possible, because all the sutures in your bones are fused. Any “expansion” achieved as an adult is the result of pushing the teeth out of the bone and teeth tipping. Any evidence you may see to the contrary does not exist. It is a hallucination and does not deserve discussion.

Camp 2: The Enlightened Fringe People. Dentists and orthodontists are stupid and barbaric and they are 100% wrong always. We expand adult palates all the time with great success, and the fear of “pushing teeth out of the bone” is silly and unfounded and does not deserve discussion.

You guys, I was SO hoping that the Enlightened Fringe People were right. But as usual, the truth is somewhere in the middle.

My theory? I don’t think Ian and Brad are lying that they’ve expanded hundreds of adult palates without pushing teeth out of the bone. But I also think they didn’t check for it. You can have dehiscence without losing teeth – I mean, you have to push teeth really far for them to actually fall out. It’s entirely possible that had I continued expansion without doing the CBCT scan, I would’ve lost all of the bone covering the roots of my upper teeth, but I wouldn’t have known. And maybe the bone would have partially (or even fully) regrown, eventually. That seems like something the body would do, after all.

I’ll be exploring this much more in the future, but for now, just remember that nothing is black and white. And just because someone is sure they’re right, and you want them to be right, doesn’t mean that they are.

The Crane update

I do plan to continue trying to use the Crane while I am paused, because (in my mind, at least) the goal of the Crane is to pull the entire maxilla forward, which should have very little impact on the movement of individual teeth, and therefore shouldn’t worsen the dehiscence situation. And guess what?! I actually managed to wear the Crane all night (while sleeping!) for an entire week! I guess I finally got used to having it around my neck, and while it’s still really not comfortable and my neck is usually a bit sore in the morning, it’s manageable.

I’ve fallen off the wagon again because I’ve had a lot going on recently and needed to prioritize a good night’s sleep, but I feel confident that once things settle down, I’ll be able to consistently wear it and hopefully start seeing some results that way.

Alright, that’s all I have for you for now! It’s been so great seeing you guys following along, so always feel free to comment :)

 

20 Thoughts on “Palate Expansion Update: Concerning CBCT Scan Results

  1. I hope everything works out for you soon! Please keep us posted. I need to expand forward.

    • Thanks so much Sparkle! I definitely plan to continue posting updates. I need to expand forward as well – much more so than laterally. Are you planning to try anything to expand?

  2. Christofer Altin on September 21, 2018 at 7:53 am said:

    I am sorry to hear about your recent development. Ronald Ead, a 27 year old man, had similar results using a similar palatal expander. He aborted his expansion process, let the bone heal for a number of months and then started again but with a different type of an expander, an AGGA. Here is a link where he shows his bad experience with his acrylic palatal expander: https://ronaldead.com/blog/2018/2/3/failed-attempt-at-adult-palatal-expansion

    To see his progress with the AGGA, just see any recent post on his site, http://www.ronaldead.com

    So hopefully you have not caused too much, if any, permanent damege. Hopefully you can recover.

    It is unfortunate that you only recently started mewing. Mewing is another term for applying “good oral posture”. Doing so while young, combined with sufficient chewing, will ensure proper maxilla development according to the Mews and many other doctors. The fact that many modern humans grow up with a soft diet (not chewing sufficiently throughout the days, and little resistance while chewing), and sometimes also allergy issues (which may result in increased mouth breathing and thus bad oral posture) are two major reasons why so many modern humans have underdeveloped maxillas these days. Fossil finds show how humans always have developed maxillas to its full potential, making room for all 32 teeth, throughout our entire history up until our diets changed not that long ago. Fossil finds show how maxillas only about 1000 years ago, or even today in certain parts of the world, are much better developed on average. This according to the Mews as well as for example professor Paul Ehrlich, and many others.

    I am a 31 year old man from Sweden that realized I had a very underdeveloped maxilla 14 months ago. I have lived with bad oral posture probably my entire life (allergy issues). I have been mewing hard constantly + chewing a lot since then. My maxilla has grown, my breathing has improved, my face has changed for the better. If you are interested in progress pictures I can send you some.

    I think that palatal expanders such as the one you used can be of help for some while it seems to just cause trouble for others. I believe that a safer way to go about it is to mew while using a much less invasive expansion device, such as the ALF appliance or the AGGA. I will most likely use an ALF appliance myself in the near future as I continue to mew.

    Here is a video that most likely will be of great use for you: https://www.youtube.com/watch?v=cjd05J7d33U
    That is Dr Anne-Maree Cole. She is very experienced with the AGGA appliance, so she knows first hand that even adults can grow their maxillas efficiently in a physiological way given the right stimuli.

    I also recommend you to view videos with professor Paul Ehrlich and orthodontist Sandra Kahn on youtube. They talk about the ongoing epidemic with underdeveloped maxillas in modern societies. They have released a book recently on the issue. They back their claims up with fossil finds.

    Then of course there is plenty of material on the orthotropics youtube channel which I assume you are already very familiar with.

  3. Christofer Altin on September 21, 2018 at 8:18 am said:

    To add to the comment I just wrote (read it before reading this one):

    I am not a doctor or a dentist, but if I were in your position I would consider removing the device even during nights so that your teeth can return to better positions and so that your bone can heal as much as possible. You are still very young and this is not a race.

    Once you are in a good healthy state bonewise I think you can consider using devices again while mewing. You could also consider just mewing alone. However, it is believed that adults change very slowly by mewing alone. I seem to have been an exception in this regard, possibly because I started at a very narrow underdeveloped state (I saw quite massive lateral gains during the first 5 months of intense nonstop mewing).

    I believe the ALF appliance and the AGGA are two good appliances that you could consider. They work with very light constant forces that according to the doctors using them result in physiological change. Meaning that the change is not only a result of mechanical force, it is to a large degree a result of the nerves responding to the stimuli that is being provided, which results in growth/remodeling. The ALF pushes very gently against certain teeth and certain gum areas. It is also designed to promote maximum tongue usage. The AGGA only pushes very gently against a certain spot in the hard palate (the same way the tongue can push against this spot while mewing). The AGGA does not push against any teeth at all, it only guides the 6 frontal teeth forwards together with the anterior part of the maxilla as expansion takes place.

    The AGGA (also called the “FAGGA” btw) is very pricey though. The ALF is pretty cheap, at least where I live: About 800 dollars to produce and install and treatment costing about 1500 dollars for a year. So treatment cost is the main cost with the ALF.

    Mike Mew recently recommended combining mewing with the ALF appliance in his latest Q&A video, seen in this post: https://the-great-work.org/community/main-forum/mike-mew-qa-response-video-2/

    If you are not already familiar with the forum in question I encourage you to check it out: https://the-great-work.org/

    • Hi Christofer,

      Thanks so much for both your comments! Yes, I’m already pretty familiar with all of Dr. Mew’s work, and The Great Work forum, but I had never heard of the AGGA. It’s amazing to me how easy it is to miss things online, even after putting in hours of research on the topic. One thing I’m hoping to eventually do is attempt to organize all of this information in one place so it’s easier for people to access.

      Anyway, thank you! I agree that the ALF and the AGGA sound much more appealing, if/when I decide to expand with an appliance again. I did consider the ALF before I started treatment, but of course all the info about the DNA said similar things about it not moving teeth with “mechanical force,” but as a “result of nerves responding to the stimuli.” Which I now think is probably BS. It seems far more likely that that could be true of the ALF or AGGA, based on how they’re designed. Oh well, hindsight is always 20/20!

      And yeah, I’ve been considering whether I should still be wearing the appliance at night. On the one hand, it would be painful to lose 6 months of expansion progress, but on the other, it’s not really “progress” if my teeth aren’t in a healthy place. And usually when I put it in at night, it feels a little tight, which means my teeth were trying to move back during the day.

      The problem is, I grind my teeth horribly at night. I’m hopeful that eventually will stop once I’ve expanded my maxilla more, but for now, I really need to wear something at night to protect my teeth. And with all the expansion I’ve done, none of my previous night guards fit! So the occlusal plates of the DNA have been functioning as a night guard since I started wearing it. The other problem is that I do want to keep wearing the Crane at night, and if I stop wearing the DNA, I’ll have nothing to attach it to.

      What I think I’ll do for now is just do reverse turns of the expansion key every night until the appliance doesn’t feel tight anymore, so I’m accommodating my teeth moving back but I can still wear the appliance. I know it’s probably not ideal, but none of this really is, you know?

      Anyway, I really appreciate your thoughts and feedback. It’s super helpful getting an outside opinion, and I love hearing about new people/websites/resources on this topic. I hope you’ll stick around :)

      • Christofer Altin on September 21, 2018 at 11:18 am said:

        I will definitely stick around. I saved a link to this blog in one of my many documents with collected info about this whole maxilla phenomena.

        Given your circumstances it seems like you have a good idea of how to proceed. It is indeed a lot of different devices out there and conflicting information, certain dentists saying something is impossible and others saying it is fully possible. Whether the ALF actually works in adults, as in whether it actually produces significant change in a reasonable timeframe, I do not know. I have read and been told a lot of good things about it but it is unfortunate that there pretty much are no cases to be found for it despite it having been used for decades..

        At the same time, certain doctors speak very well about it and say that have successfully expanded adult maxillas with it for a long time, like this doctor: https://www.youtube.com/watch?v=MIG5EbvQzs8

        Since it works with very light forces, and since it enables proper mewing while wearing it, and since it is relatively cheap, I see it as a safe option to consider for the time being at least. I have my eyes on the AGGA for the future though, if I may need it. Ronald Ead have shown very clearly how efficient it can be. In addition to his webpage he also has a youtube page. In this video, that he posted yesterday, he sums up what the AGGA did for him: https://www.youtube.com/watch?v=0n8eAi2yIWw

        I hope you can get proper tongue posture to work. I did a lot of tongue strengthening exercises in the beginning in addition to forcing myself to apply good oral posture constantly throughout the days. Mostly I pushed with my tongue upwards as hard as I could in repetitions, this way I could really fatigue my tongue muscle and strengthen it.. It was a bit uncomfortable in the beginning to force proper tongue posture but eventually it developed into a habit that I just did without thinking about it. After about 3 months I started sleeping with the tongue in the roof of my mouth consistently, so at this point it happened whether I thought about it or not. The way it is supposed to happen according to the Mews, professor Paul Ehrlich, Dr. Cole, Dr. Hang, and many others.

      • Christofer Altin on September 21, 2018 at 11:39 am said:

        I forgot to include one thing in my latest reply:

        You say that you do not want to loose the expansion you have achieved by removing the device fully. Perhaps that is a wise decision. I have heard about people expanding and then loosing a certain amount of it shortly thereafter.

        However, this is precisely why certain doctors/dentists puts a lot of emphasis on tongue posture. The tongue expands the maxilla in growing people (and even in adults assuming the maxilla never developed the way it should have, at least this has been my case thus far, and many others at TheGreatWorks forum say similar things), but it also maintains the expansion that has taken place. So for the future you should try to reach such a state with your oral posture.

        So keep in mind that expanding laterally more than your tongue can maintain, while it is positioning correctly against the roof of the mouth, is pointless for this reason.

        For the time being I take it that you do not sleep with your tongue in the roof of the mouth. So perhaps your current plans of not throwing the device away may be the right call.

        • Christofer Altin on September 21, 2018 at 11:44 am said:

          put*, not puts. I rewrote that piece of text and did not change the word in question.

          I am taking this opportunity to also point out that I actually have been mewing with constant force, as opposed to just mewing by relying on a suction hold against the roof of the mouth (with a relaxed tongue). Whether this is ideal or not I do not know. Perhaps in adults like myself it is. Perhaps it can be risky though.

        • Christofer Altin on September 21, 2018 at 1:30 pm said:

          I wrote “The tongue expands the maxilla in growing people”. I should have written the following: Proper oral posture combined with sufficient chewing grows the maxilla in young people to its genetic potential. Proper oral posture ensures that the maxilla grows forwards and laterally, as opposed to less forwards/laterally and more vertically.

          This I am sure you are already aware of, I just wanted to correct what I wrote above.

        • Christofer Altin on September 21, 2018 at 3:09 pm said:

          To add: And since you want to be able to facepull, it makes sense to keep it in for the time being so that you can facepull with it as you explained.

          Perhaps the device can be used in the future, perhaps a slower expansion rate could be worth a try?

          On the other hand, perhaps mewing + an AGGA or an ALF would be the better route.

          I wish you the best of luck whatever you end up doing. It is a shame that the doctor in question treated you the way he did. It seems it did not affect your spirit much though, glad to see that. I applaud people like you and Ronald, showcasing your trial and errors for everyone to see and learn from. Really hope you the very best.

          • Glad to hear you’ll be sticking around, Christofer! Thanks for all your additional comments. I definitely prefer the idea of mewing + ALF/AGGA over trying to start expanding my existing appliance again, even at a slower rate, but then I have the tricky aspect of needing something to facepull with. I guess I’ll just take one step at a time and see how it goes!

  4. Your blog about your experience has been really useful to follow. I think it should be noted that technically you weren’t using a DNA appliance, but a meridian expander. Even though Dr. Lockhart didn’t seem concerned about this difference, in the back of my head I can’t help but hold out hope that maybe the difference in appliance design and rate of expansion matters.

    It’s possible that made a difference, also possible it didn’t. As you said, the truth is somewhere in the middle. Whatever the case is, it’s quite concerning that Dr. Lockhart did not follow up with you after receiving the CBCT results. Especially after going to such effort to consult with him.

    It’s unfortunate how many doctors, on either side of debate, practice with blinders on and won’t acknowledge, let alone publish, poor treatment outcomes. Thank you for sharing your story, it fills a much needed gap in information.

    • Thank you so much Sean! I really appreciate that.

      And you’re right, I should be more specific – it’s certainly possible that the DNA is functionally different from the meridian, and I don’t want to mislead people! To be honest, I’ve leaned towards calling it a DNA simply for search engine purposes. There’s so little information on adult palate expansion out there that I wanted to make it easier for people to find my blog, and I figured more people are Googling the DNA than the meridian! But I’ll go back now and make sure that it’s clear in all my posts that I was actually using the meridian. Thanks for mentioning that.

      Completely agree about doctors not acknowledging poor treatment outcomes. It’s a huge disservice to their patients.

  5. This sucks, I’m sorry. I have the Mrna appliance and haven’t experienced teeth tipping. However, my dentist did recently ask me to stop on the bottom row, to let the top catch up. Plus to turn the top every 10 days, versus once a week. Before I was shooting for 10-12 hours per day and turning once a week. I’ll need to update my experience this week, its been a crazy month.

    • Thanks Scott :) Just hopped over to your blog to read your updates – it has been a crazy month for you! Sorry to hear about the breakage. My appliance is also barely hanging in there with the extreme grinding/clenching that I do at night, so I feel your pain. Super cool that you’ve noticed benefits with mental clarity – that’s a great sign!

      Wearing for only half the day and turning less frequently sounds like it’s probably a much smarter approach than what I was doing. Gives your palate more time to actually expand. If/when I decide to start expanding again, it will be a MUCH slower process!

  6. scottgetsmouthy.wordpress.com

  7. Im really sorry to hear about your setback – hopefully you will be back on track in no time.

    May I ask how many hours per day you were wearing the appliance for? My dentist told me that the key to prevent teeth tipping is to never use it for more than 16 hours per day. Were you going above 16 hours?

    Also, Ive read that 30 minutes per day of gum chewing can also help prevent teeth tipping. Were you incorporating any chewing into your daily routine?

    • Hey, thanks Zach! I was wearing it for at least 20 hours per day – basically whenever I wasn’t eating or brushing my teeth. As far as chewing – for some reason, I’ve always naturally been a mega-chewer, to where it can easily take me an hour to eat a meal. So between that and my occasional TMD issues, I will probably never purposefully add more chewing to my day. At least not until I fix my bite enough that chewing doesn’t aggravate my jaw joint!

      To be clear though, teeth tipping was not a problem for me. It was actually the entire tooth/root being pushed laterally outside of my palate bone, because my teeth were moving faster than my palate bone was expanding.

      That said, I imagine wearing the appliance less often and expanding at a slower rate could have prevented that from happening!

  8. Sorry to hear the the news about the CBCT. I am curious to know if the same radiologist reviewed your original scan and is comparing the follow up to the original. Could it be that the issue pointed out in the progress scan could have already existed but just wasn’t mentioned at the time of the original scan?

    • Hey David! That was actually my first thought too, but unfortunately, we didn’t take a CBCT scan prior to starting the treatment. Nobody suggested it to me, and I still didn’t know enough at the time to request one. But boy do I wish I had one for comparison!

      So while it’s certainly possible that the issue already existed, it seems pretty unlikely. My bottom jaw doesn’t have the same issue, and it’s an objectively less healthy state for the roots to be in, so I can’t really pass it off as harmless individual variation.

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